From CBC:
“Cancer doctors are calling for a
permanent fix to drug shortages in Canada”
Cancer specialists are concerned
national shortages of three vital cancer drugs could lead to a time when they
could run out of treatment options for patients in Canada. The three drugs are
all injected into patients' veins. The
federal government's drug shortage reporting website lists all three as
experiencing national shortages, meaning the scarcity problem could affect
patients throughout the country. At hospitals in Ontario, Quebec, Nova Scotia
and New Brunswick, oncologists, pharmacists and nurses have all scrambled to
find alternatives, make substitutions and share precious vials. "My point
in raising this publicly is not to alarm patients," Dr. Gerald Batist,
director of the Segal Cancer Centre at Montreal's Jewish General Hospital. "But to start to bring this into the
public discourse so that we have some pressure on our government and on drug
producers to find a solution to this. "It's not really clear that any
efforts are being made to solve this problem in a more permanent
way." Medical oncologist Dr. Gerald Batist, director
of the Segal Cancer Centre at Montreal's Jewish General Hospital, says it's
time to put pressure on the federal government and drug producers to fix the
problem. (CBC) The drugs include vinorelbine, which treats non-small cell lung
cancer and metastatic breast cancer. Leucovorin is often used in combination
with chemotherapy drugs to decrease their toxic effects. Etoposide treats lung
cancer and testicular cancer. It can also accompany bone marrow transplants. In
an email to CBC News, Health Canada said it "recognizes the impact that
these shortages have on the patients who rely on these important medications
and is taking action to address them." Dr. Bruce Colwell, a medical
oncologist at QEII Health Sciences in Halifax, sees more frequent drug
shortages at his hospital. "I've
dealt with sometimes two, three [shortages] but eight is for me a record,"
said Colwell, who's also president of the Canadian Association of Medical
Oncologists. He hasn't reached the
frightening point of telling a patient that treatment has been stopped because
of a shortage.
Short notice concerns
The problem is that hospitals
often hear about shortages with as little as one day's notice. Staff scramble
to find alternative drugs that work equally well but may have a shorter track
record. Geoff Eaton, 43, said patients need to be the central focus of
suppliers, pharmaceutical companies and governments. He was first diagnosed
with acute myeloid leukemia at age 22. "I didn't have months or years to
wait," he said. "I had a very small window that I had to access this
treatment." In his 20s, Geoff Eaton was told there would be challenges to
getting the best cancer treatment. He was told a nursing shortage in Toronto in
2001 would mean an extra round of chemotherapy. When the St. John's resident
needed etoposide during a relapse in 2001, he was told a nursing shortage in
Toronto would mean an extra round of chemotherapy. He pushed for — and received
— a bone marrow transplant in Ottawa instead. "It's a very tough situation," said
Eaton, executive director of Young Adult Cancer Canada, a group that organizes
support for young cancer patients. "You are kind of faced with this
unexpected additional burden and challenge amidst probably the most challenging
situation of your life." Earlier this year, Health Canada said it
facilitated import of an international supply of etoposide as a short-term
measure until the anticipated shortage end date of Sept. 30. Three intravenous cancer drugs in particular
are in short supply in Ontario, Quebec, Nova Scotia and New Brunswick. (CBC) Sandoz
Canada, one of the companies reporting a shortage of etoposide, said the supply
"has been disrupted due to a manufacturing set-up change to maintain our
product's highest quality standards. For now, the reintroduction is planned for
the second quarter of 2020." Vinorelbine shortages were reported by Fresenius
Kabi Canada Ltd, Teva Canada Ltd. and Generic Medical Partners Inc. (GMP). "GMP has reported that it is implementing
a distribution strategy in order to supply product at 75 per cent of the demand
for orders received and it is seeking to increase production to meet national
demand by October 2019," Health Canada said. The federal department said
it continues to monitor the supply closely.
Discontinuation and disruptions
Pfizer said it discontinued
vinorelbine "after a careful evaluation of the availability of other
treatment options in Canada." It's unknown when Teva and Pfizer Canada's
leucovorin shortage will be resolved. Health Canada said it's working with
companies "to explore the possibility of accessing international supply as
soon as possible." But Batist is losing patience. "They talk about problems with shipping,
which is a little bit unusual for 2019," he said. "We're having a
great deal of difficulty finding credible excuses." The three drugs are no
longer patented and there's little incentive for manufacturers to keep up inventories,
Batist said. He suggested legislation might be needed to force drug makers to
make products available if they want to sell medicines.
^ Canadians were worried that
Americans being able to buy prescription medicines from Canada would lead to
medicine shortages across the country. That is already the case. The
universal-health care system used in Canada may cover every Canadian citizen
(except those that leave Canada for 6 months or longer) but it also leads to
very long waits to see a doctor and get treated as well as a shortage of
medicines. The Canadian Federal, Territorial and Provincial Governments need to
do a lot more to fix these major problems because just saying you have
universal health care is not enough. You also have to back that up with action
and having shorter wait times and no more shortages is real action and not mere
words. There’s no point in having something on paper if it’s not in practice. ^
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